Prevalence of MRSA in elective day case pediatric ENT surgical patients.

OBJECTIVES: Meticillin-resistant Staphylococcus aureus (MRSA) is a common pathogen implicated in hospital acquired infection. Routine preoperative screening for MRSA is current health policy in England and Wales, although children undergoing elective, routine ENT surgery are excluded from this policy. We prospectively assessed a cohort of children admitted for elective ENT surgery to assess this policy. METHODS: We examined 348 pre-operative children having routine ENT operations to assess MRSA carriage. RESULTS: We found bacteriological evidence of MRSA in only one child of the 348 tested. CONCLUSIONS: This study confirms the current policy and has implications for other countries.

Chickenpox at Ninety Four: A Case for Extending the Use of Varicella Vaccine in the UK.

A case of chickenpox in a 94-year-old female is described. Serological tests for Varicella zoster virus (VZV) performed on early and late serum samples confirmed primary VZV infection. The patient recovered but seventeen days after presentation she developed a stroke from which she subsequently died. Chickenpox in older people is relatively rare-this case may be the oldest case of laboratory-proven chickenpox described-but it is a life-threatening illness. The varicella vaccine is licensed for use in immunocompetent persons of 12 months of age or older but in the UK is only offered to susceptible healthcare workers and close contacts of immunocompromised patients. In the US, the vaccine is recommended for all susceptible adolescents and adults. The same recommendation should be made in the UK.

Molecular epidemiology of human enterovirus 71 in the United Kingdom from 1998 to 2006.

The last decade witnessed a significant increase in epidemic activity of human enterovirus 71 (EV71) in the Western Pacific Region (WPR). In most European countries, this risk is unrecognized despite occasional cases of severe disease and two severe outbreaks in Eastern Europe 30 years ago. In this study we report the first examination of the molecular epidemiology of EV71 in the United Kingdom from 1998 to 2006. Genomic regions encoding the 1D coat protein (VP1) and 3D polymerase (Pol) from 32 EV71 isolates associated with neurological or cutaneous manifestations were sequenced. Phylogenetic analyses of VP1 and 3D Pol sequences identified genotype C as the dominant strain. Several United Kingdom isolates had genetic linkages with predated C1 or C2 strains from Europe and the WPR. Recombination events were not detected between United Kingdom strains. However, a previously published Taiwanese strain was identified as an intergenotypic recombinant. EV71 genotype C appears to have continuous circulation in the United Kingdom from 1998 to 2006 with repeated introductions of new strains replacing previous strains. It is necessary to continuously monitor the molecular evolution and recombination events of EV71.

The Lim Benyesh-Melnick antiserum pools for serotyping human enterovirus cell culture isolates--still useful, but may fail to identify current strains of echovirus 18.

Neutralisation tests are often used as a second line method of serotyping human enterovirus cell culture isolates after failure of indirect immunofluorescence. We reviewed the results of 85 consecutive neutralisation tests performed routinely on presumptive enterovirus isolates using the Lim Benyesh-Melnick antiserum pools after failure of immunofluorescence on most of them, in order to assess the value of these antiserum pools. Confirmation of serotype was determined by partial VP1 genome sequencing. Forty isolates were serotyped successfully and 45 isolates were untypable by the LBM pools, although 16 of the latter would not be expected to be typable by this means. Of eighteen echovirus 18 isolates tested, only two were typable by neutralisation. Of 15 coxsackievirus A16 isolates only nine were typable by neutralisation. Neutralisation with the LBM pools remains a useful second line method of serotyping human enteroviruses despite difficulties with at least two serotypes.

Vertical transmission of human echovirus 11 at the time of Bornholm disease in late pregnancy.

We report a case of human echovirus 11 infection in a neonate at the time of Bornholm disease in late pregnancy of the mother. Mother and baby were found to be infected with the same virus, with a combination of diagnostic virologic techniques, demonstrating likely transmission from mother to baby around the time of delivery.

Coxsackievirus B3 sequences in the blood of a neonate with congenital myocarditis, plus serological evidence of maternal infection.

A fatal case of myocarditis in a neonate is described. The clinical features were evident at birth, and enteroviral RNA was detected in the blood of the baby on the day of birth and again 10 days later by a generic enterovirus nested reverse transcription-polymerase chain reaction (RT-PCR) assay. The enterovirus RNA was subsequently retested by a separate, newly developed nested RT-PCR assay yielding a PCR product within the VP1 coding region suitable for sequencing. Identical 239-base pair sequences were obtained from the RNA of the two blood samples and this sequence most closely resembled coxsackievirus B3 (94% identity). The baby's mother was pyrexial immediately postpartum and an early antenatal serum and a serum sample collected 10 days postpartum tested in parallel for enterovirus IgM antibody showed negative to strong-positive seroconversion. Infection of the mother was the likely primary event with in utero transfer of the virus to the fetus in the last few days of pregnancy. Neonatal blood is a valuable specimen for enterovirus diagnosis by RT-PCR. A newly developed nested RT-PCR assay was successful in typing the enterovirus from stored RNA extracted directly from the blood samples. Serology for enterovirus IgM antibody can be useful for convalescent diagnosis of enterovirus infection in the mother, especially with earlier serum for comparison.